The Social and Spiritual Factors Affecting Chronic Renal Dialysis Patients in Gaza Strip

Background: End-Stage Renal Disease (ESRD) is a progressive worsening of kidney function over a period of months or years. It is a complex debilitating disease that needs a lifelong treatment. Because patients with ESRD cannot be cured of their underlying conditions and mostly underwent hemodialysis program, it usually leads to many physical and medical consequences and complications, and beside them, there are lots of concealed social and spiritual factors that can affect people who have this disease or are on renal dialysis. Some studies about medical and clinical consequences of ESRD and renal dialysis were conducted but this study will be the first one to determine the factors affecting the social and spiritual wellbeing of patients who are on renal dialysis in Gaza Strip. Objectives: It is important to give a detailed picture about the social and spiritual wellbeing of patients who are on renal dialysis to

Awareness and factors influencing breast reconstruction in the Gaza Strip: a cross-sectional study

Background Women are usually given two options after a mastectomy. They can either wear a prosthesis or have a breast reconstruction. Unfortunately, many women in the Gaza Strip are unaware of these options. The aim of this study was to shed light on the awareness and sociocultural factors in women who underwent mastectomy before choosing between options. Methods In this cross-sectional study, we recruited patients who underwent mastectomy in the Gaza Strip. All participants completed a face-to-face questionnaire between Aug 1, 2015, and April 30, 2016. Verbal consent was obtained from all participants. Findings 173 women with a mean age 51 years (SD 10) were enrolled in this study. 90 (52%) women had low income, and 36 (21%) women had a first-degree relative with breast cancer. 133 (77%) women underwent radical mastectomy, and 29 (17%) women had breast-conserving surgery. 96 (55

Impact of mastectomy on the social well-being and family dynamics of breast cancer female patients in the Gaza Strip

Background: The impact of mastectomy on social well-being (SWB) and family dynamics (FD) may involve the individual, social role and perception of the usefulness of social and family support affects. The purpose of the current study is to identify that impact and its related implications on SWB and FD. Methods: This was a cross-sectional study in which a total of 173 female patients who had mastectomy in GS hospitals completed a face-to-face questionnaire designed by the researchers; which contains 3 sections including: socio-demographic data, SWB and FD. All measures utilized a five-point Likert-type scale ranging from 1 (worst outcome) to 5 (best outcome). The study was conducted at European Gaza Hospital (n= 60) and Alshifaa Hopsital (n= 113) in the GS from August 2015 to September 2016. The data was analyzed using SPSS software. Results: Among 173 female patients, the mean age was 51 years

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

علاج المرضى في بيئة آمنة: دراسة مقطعية لمواقف الأطباء في قطاع غزة عن سلامة المرضى بين ، فلسطين

Background: Patient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes. Methods: Doctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace. Results: A total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain “Working hours as a cause of errors” (4.16) and the lowest score by “Importance of Patient Safety in the Curriculum” (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety. Conclusion: Doctors in Gaza demonstrated relatively positive patient safety attitudes in areas of “team functioning” and “working hours as a cause for error”, but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.خلفية البحث: تعتبر سلامة المرضى ذات أهمية قصوي، كما هو الحال في الأنظمة الطبية المتزايدة التعقيد ، تزداد أيضًا احتمالية حدوث ضرر غير مقصود للمرضى. قيمت هذه الدراسة اتجاهات الأطباء في قطاع غزة تجاه سلامة المرضى والخطأ الطبي. كما استكشفت المتغيرات التي أثرت على مواقفهم. طرق البحث: تمت دعوة الأطباء ، الذين يعملون لمدة 6 أشهر على الأقل في أحد المستشفيات الحكومية الرئيسية الأربعة في قطاع غزة ، لتعبثة النسخة العربية من استبيان المواقف تجاه سلامة المرضى (III (APSQ-III) ؛ والتي تقيم مواقف سلامة المرضى في تسعة مجالات ، بغض النظر عن مكان العمل. النتائج: شارك في هذه الدراسة ما مجموعه 150 طبيبًا من أربعة مستشفيات حكومية ، يمثلون 43.5٪ من إجمالي 345 طبيبًا يعملون في المستشفيات الأربعة التي خضعت للدراسة في وقت الدراسة. كان متوسط ​​العمر 36.6 (± 9.7) سنة. الغالبية (72.7٪) من الذكور ،يعمل 28.7٪ في الجراحة ، 26.7٪ في طب الأطفال ، 23.3٪ في الباطنة ، 16.7٪ في التوليد وأمراض النساء ، و 4.7٪ في الأقسام الأخرى. معظم المشاركين (62.0٪) لم يتلقوا أي تدريب على سلامة المرضى. كانت النتيجة الإجمالية APSQ 3.58 ± 0.3 (بحد أقصى 5). تم الحصول على أعلى درجة في البند "ساعات العمل كسبب للأخطاء" (4.16) وأدنى درجة في البند "أهمية سلامة المريض في المنهج الدراسي" (3.25). كان لدى الأطباء الأكبر سنًا الذين يتمتعون بخبرة مهنية درجات أعلى بكثير من الأطباء الأصغر سنًا (p = 0.003) ، مما يدل على مواقف أكثر إيجابية تجاه سلامة المرضى. علاوة على ذلك ، أصبحت مواقف سلامة المرضى أكثر إيجابية مع زيادة سنوات الخبرة في بعض المجالات. ومع ذلك ، لم يتم العثور على تأثير كبير على درجات APSQ الإجمالية حسب مكان العمل أو التخصص أو ما إذا كان المشاركون قد تلقوا تدريبًا سابقًا حول سلامة المرضى. النتائج: شارك في هذه الدراسة ما مجموعه 150 طبيبًا من أربعة مستشفيات حكومية ، يمثلون 43.5٪ من إجمالي 345 طبيبًا يعملون في المستشفيات الأربعة التي خضعت للدراسة في وقت الدراسة. كان متوسط ​​العمر 36.6 (± 9.7) سنة. الغالبية (72.7٪) من الذكور ،يعمل 28.7٪ في الجراحة ، 26.7٪ في طب الأطفال ، 23.3٪ في الباطنة ، 16.7٪ في التوليد وأمراض النساء ، و 4.7٪ في الأقسام الأخرى. معظم المشاركين (62.0٪) لم يتلقوا أي تدريب على سلامة المرضى. كانت النتيجة الإجمالية APSQ 3.58 ± 0.3 (بحد أقصى 5). تم الحصول على أعلى درجة في البند "ساعات العمل كسبب للأخطاء" (4.16) وأدنى درجة في البند "أهمية سلامة المريض في المنهج الدراسي" (3.25). كان لدى الأطباء الأكبر سنًا الذين يتمتعون بخبرة مهنية درجات أعلى بكثير من الأطباء الأصغر سنًا (p = 0.003) ، مما يدل على مواقف أكثر إيجابية تجاه سلامة المرضى. علاوة على ذلك ، أصبحت مواقف سلامة المرضى أكثر إيجابية مع زيادة سنوات الخبرة في بعض المجالات. ومع ذلك ، لم يتم العثور على تأثير كبير على درجات APSQ الإجمالية حسب مكان العمل أو التخصص أو ما إذا كان المشاركون قد تلقوا تدريبًا سابقًا حول سلامة المرضى

نظرة الأطباء والممرضين إلى سلامة المرضى الطبية في قطاع غزة: دراسة مستعرضة

Objectives This study examined the attitudes of nurses and doctors to key patient safety concepts, evaluated differences and similarities between professional groups and assessed positive and negative attitudes to identify target areas for future training. Setting Four major governmental hospitals in the Gaza-Strip. Participants A convenience sample of 424 nurses and 150 physicians working for at least 6 months in the study hospitals. Primary and secondary outcome measures The primary outcome measures were mean scores with SD as measured for individual items and nine main patient safety domains assessed by the Attitudes to Patient Safety Questionnaire. Secondary outcome measures were the proportions of doctors and nurses, that gave a positive response to each item, represented as percentage of each group. Results Nurses and doctors held moderately positive attitudes towards patient safety with five out of nine domain scores >3.5 of 5. Doctors showed slightly more positive attitudes than nurses, despite a smaller proportion of doctors having received patient safety training with 37.5% compared with 41.9% of nurses. Both professions displayed their most positive patient safety attitudes in the same domains (‘team functioning’ and ‘working hours as a cause for error’), as well as their two most negative attitudes (‘importance of patient safety in the curriculum’ and ‘professional incompetence as a cause of error’), demonstrating significant deficits in understanding medical errors. A specific challenge will be the negative attitudes of both professions towards patient safety training for wider dissemination of this content in the postgraduate curriculum. Conclusion Patient safety attitudes were moderately positive in both professional groups. Target of future patient safety training should be enhancing the understanding of error in medicine. Any training has to be motivating and relevant for clinicians, demonstrating its importance in ongoing professional learning.الأهداف: درست هذه الدراسة مواقف الممرضين والأطباء لمفاهيم سلامة المرضى الرئيسية ، وتقييم الاختلافات والتشابهات بين المجموعات المهنية وتقييم المواقف الإيجابية والسلبية لتحديد المجالات المستهدفة للتدريب في المستقبل. المكان: أربعة مستشفيات حكومية رئيسية في قطاع غزة. المشاركون: عينة مكونة من 424 ممرضًا و 150 طبيبًا يعملون لمدة 6 أشهر على الأقل في المستشفيات التي شملتها الدراسة. النتائج: أبدى الممرضون والأطباء مواقف إيجابية معتدلة تجاه سلامة المرضى في خمسة من أصل تسعة مجاللات. أظهر الأطباء مواقف إيجابية أكثر قليلاً من الممرضين ، على الرغم من أن نسبة أقل من الأطباء تلقوا تدريبات على سلامة المرضى الممرضات. عرض كلا العاملين في المهنتين مواقفهم الإيجابية في سلامة المرضى في نفس المجالات ("عمل الفريق" و "ساعات العمل كسبب للخطأ") ، وكذلك موقفيهما الأكثر سلبية ("أهمية سلامة المرضى في المناهج الدراسية" و " عدم الكفاءة المهنية كسبب للخطأ ') ، مما يدل على وجود عجز كبير في فهم الأخطاء الطبية. سيكون التحدي الأصعب هو المواقف السلبية لكلتا المهنتين تجاه التدريب على سلامة المرضى من أجل نشر أوسع لهذا المحتوى في المناهج الدراسية للدراسات العليا. الاستنتاج كانت مواقف سلامة المرضى إيجابية إلى حد ما في كلا المجموعتين المهنية. يجب أن يكون هدف التدريب على سلامة المرضى في المستقبل تعزيز فهم الخطأ في الطب. يجب أن يكون أي تدريب محفزًا ومناسبًا للأطباء ، لإظهار أهميته في التعلم المهني المستمر

A GIS-Based Groundwater Contamination Assessment Using Modified DRASTIC Geospatial Technique

Groundwater contamination along with anthropogenic actions and land use forms are increasing threats in urbanized zones around the world. Additionally, water quality and quantity are declining due to urbanization development. DRASTIC parameters (depth to the water table, net recharge, aquifer media, soil media, topography, impact of the vadose zone, hydraulic conductivity) were considered to investigate hydrological characteristics for assessment of contamination. Having a major effect of anthropogenic activities, various susceptibility zones were produced by modifying the DRASTIC model into DRASTICA, integrating anthropogenic effects as the “A” parameter in an alphabetic system. After the assessment, the research exposes that from the total area, 14% is under very high susceptibility, 44% is of high susceptibility, 39% is of moderate susceptibility, and 3% is of low susceptibility to groundwater pollution. The results in the built-up areas and based on the parameter of nitrate in quality of water show that the altered DRASTIC model or DRASTICA model proved to give better outcomes compared with the usual DRASTIC model. The policy advisers and management authorities must use the analysis data as precaution measures so that future calamities can be avoided

Intrinsic Workforce Diversity and Construction Worker Productivity in Pakistan: Impact of Employee Age and Industry Experience

Worker productivity is critical within construction projects as it is the measure of the rate at which work is performed and, more importantly, helps to know how to motivate them to perform at high levels. This research aimed to examine the impact of employee age and industry experience on the intrinsic workforce diversity factors influencing construction worker productivity. Sieving through the previous research and models and theories of analysis, the intrinsic workforce diversity was modeled into the following set of factors, i.e., income, motivation, psychosocial factors, and technical skills. The data were collected by means of a questionnaire survey and examined for the employees having different ages and experiences using the Mann–Whitney U test through SPSS. The results show that employees of varied ages do not concur over motivation-, psychosocial, and technical skills-related workforce diversity factors, whereas employees of varied industrial experiences are in disagreement over some income and motivation related workforce diversity factors. In order to overcome intrinsic workforce diversity, firm support is direly needed for old and mature employees in terms of financial incentives leading to motivation, less supervised scheduling, opportunities for firm advancement, and reporting back every time work is completed. Furthermore, support is required for young employees who are more susceptible due to psychosocial stresses like unevenly distributed work, communication gaps, and technical skills like knowledge of technological equipment and advancement in construction technology which has reduced the skills of workers

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe